| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,397 |
2,363 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,860 |
1,811 |
$42K |
| D1999 |
|
2,056 |
1,859 |
$38K |
| D1120 |
Prophylaxis - child |
1,257 |
1,237 |
$36K |
| D1110 |
Prophylaxis - adult |
950 |
930 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,071 |
957 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
199 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,007 |
997 |
$15K |
| D0272 |
Bitewings - two radiographic images |
693 |
677 |
$13K |
| D0274 |
Bitewings - four radiographic images |
528 |
512 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
77 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
240 |
$5K |
| D0330 |
Panoramic radiographic image |
84 |
83 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
15 |
12 |
$319.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$242.00 |